HBsAb Levels Research Articles

Evaluation of the immunization efficacy and adverse reactions of hepatitis B vaccination in children with thalassemia minor

ObjectiveTo assess the immunization efficacy and incidence of adverse reactions after hepatitis B vaccination in children with thalassemia based on data from real-world studies.MethodsA total of 625 children were recruited into this cross-sectional study. Subgroup analyses of different thalassemia types were performed using binary logistic regression, the factors affecting HBsAb levels were identified using multiple linear regression, and the dose-response relationship between the duration of immunization and seroconversion was explored using the restricted cubic spline (RCS) model to further assess the protective duration of the hepatitis B vaccine.ResultsHBsAb positivity in enrolled children was 87.3% in the thalassemia group and 81.4% in the control group. Multifactorial analysis revealed that the duration of immunization, age at completion of vaccination, and whether the first dose was delayed were significant factors influencing HBsAb levels in children (P < 0.05). The threshold for HBsAb positivity may be reached when the immunization duration reaches approximately 30 months. A subgroup analysis revealed that the HBsAb positivity rate was lower in children with β-thalassemia minor compared to those with α-thalassemia minor (P = 0.001, 95% CI: 0.097 ∼ 0.536). Adverse reactions after hepatitis B vaccination were dominated by general reactions, with a statistically significant difference in injection-site redness and swelling between the thalassemia and control groups (P < 0.05).ConclusionsThe immunization response to the hepatitis B vaccine in children with thalassemia minor was comparable to healthy children, with no abnormal adverse effects seen.

Evaluation of the Efficacy and Safety of Tenofovir Disoproxil Fumarate in Intercepting Mother-to-Child Transmission of Hepatitis B Virus.

Vertical transmission of hepatitis B virus (HBV), especially in Asia, is a key target in the global elimination of HBV. This study assessed the effects of tenofovir disoproxil fumarate (TDF) in pregnant women for mother-to-infant transmission of HBV. A total of 122 pregnant women at our hospital met the inclusion criteria for high HBV DNA viral loads. They were randomly divided into TDF-treatment (n=70) and placebo (n=52) groups. Maternal liver function and serum HBV DNA load were tested before and after treatment. Clinical and laboratory data of infants were assayed at delivery and 7-months post-partum visit and compared between the two groups. There was no difference in clinical characteristics of participants between the two groups. There were no significant differences in liver function markers, including alanine aminotransferase, total bilirubin, blood creatinine, and blood urea nitrogen levels before and after TDF treatment. The serum HBV DNA viral load of the TDF-treated group became significantly lower than those of the control group and their own pre-medication levels. Infants showed no significant difference in body growth, including weight, height, head size, and five-min Apgar score. At 7 months after birth, 94.29% of infants in the TDF group and 86.54% of control-group infants had protective HBsAb levels ≥ 10 mIU/ml (p>0.05). The HBV infection rate of infants in the TDF-treated group was lower than that in the non-treated group. In high-HBV-DNA-load pregnant women, TDF administered from 28 weeks gestational age to delivery was associated with a lower risk of mother-to-infant transmission of HBV.

Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study.

Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) may be at a higher risk of HBV infection reactivation, especially those on biologic therapies. This study intends to compare the effectiveness of the HBV vaccine in patients with ulcerative colitis (UC) on infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Patients with UC aged >18 years old were prospectively enrolled in the study. The patients were divided into two groups: patients treated with 5-ASA (control group) and patients treated with IFX (study group). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titers were assessed three months after the final dose. The response to HBV vaccines was categorized as an 'adequate' immune response (≥10 IU/L) and 'effective' immune response (≥100 IU/L). In our final analysis of 118 patients with UC, 54.2% were male and 52.5% had extensive colitis. HBsAb titer levels were significantly higher in the 5-ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10-99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L compared to the IFX group (76.7% vs. 12.1%, p < 0.001). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥ 100 compared to those treated with IFX (OR = 23.94, 95% CI 8.89-64.49). The immune response to hepatitis B vaccination in patients with ulcerative colitis treated with IFX is attenuated compared to those treated with 5-ASA. Therefore, emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially IFX, and advocating for screening is imperative in high-risk countries. Determining what levels of HBsAb provide protection and what happens to the levels over time after a booster dose are important clinical questions to be answered by follow-up studies.

Predictive Value of Baseline Serum Marker Levels for the Effect of Interferon Therapy in Patients With Chronic Hepatitis B

To study the changes in the serum markers in chronic hepatitis B patients who have had previous treatment with long-acting interferon therapy of nucleoside and those who have not and to assess the value of the serum markers for clinical prognosis evaluation. The clinical data of 411 cases of chronic hepatitis B were collected. All cases were given the additional treatment of long-acting interferon between October 2019 to April 2022. The cases were divided into two groups, a previously treated group consisting of patients who had been treated with nucleoside and nucleotide analogues (NAs) for more than 6 months after they became infected with hepatitis B virus (HBV) for over 6 months and an initial treatment group, or treatment naïve group, consisting of patients who had HBV infection for over 6 months and received no treatment or patients who have stopped NAs therapy for more than 6 months. The serum marker levels of the previously treated group and the initial treatment group, i.e., the previously treatment-naïve patients, were compared, and the receiver operating characteristics (ROC) curve was used to evaluate the value of the baseline levels of hepatitis B surface antigen (HBsAg) and HBV pregenomic RNA (pgRNA) for predicting the rate of cured cases in the two groups. There was no significant difference in the rate of cured cases between the previously treated group and the initial treatment group. The baseline HBV DNA, HBsAg, and hepatitis B e antigen (HBeAg) levels of the cured cases in both groups were significantly lower than those in the uncured cases (P<0.0001). After 48 weeks of treatment, the serum HBsAb levels (mIU/mL) of the cured cases in both the previously treated and initial treatment groups were significantly higher than those of the uncured cases in the two groups (previously treated group: 78.97±22.57 vs. 0.99±0.38, P<0.0001; initial treatment group: 235.50±175.00 vs. 1.32±0.88, P<0.0001). The serum HBsAb levels (mIU/mL) of the cured cases in the initial treatment groups were significantly higher than that of cured cases in the previously treated group (235.50±175.00 vs. 78.97±22.57, P<0.0001). Within 0 to 60 weeks of treatment, HBV pgRNA levels of cured cases in both groups were significantly lower than those of the the uncured cases in both groups (P<0.0001). Multivariate logistic regression and ROC curve analysis showed that baseline serum HBsAg was the influencing factor and predictor of interferon efficacy in both the previously treated cases and the initial treatment cases, with the area under the curve (AUC) being 0.80 (95% confidence interval [CI]: 0.7423-0.8615, P<0.0001) and 0.74 (95% CI: 0.6283-0.8604, P=0.0079), respectively, and the optimal cut-off values being 244.60 IU/mL and 934.40 IU/mL, respectively. However, the baseline serum HBV pgRNA level of under 1340.00 copies/mL in the initial treatment cases led to better sensitivity and better specificity in efficacy prediction, with the AUC of the baseline HBV pgRNA being 0.9649 (95% CI: 0.9042-1.0000, P<0.0001). Among the previously treated cases and the initial treatment cases, patients who achieve clinical cure have lower levels of HBV DNA, HBsAg, and HBeAg at baseline, lower level of HBV pgRNA over the course of their treatment, and higher level of HBsAb at week 48. Baseline HBsAg levels can be used to effectively predict the clinical cure outcomes in previously treated cases and initial treatment cases. Baseline HBV pgRNA levels also exhibit a high predictive value for treatment outcomes in initial treatment cases.

P914 Immunogenecity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Monotherapy : A Prospective Comparative Study

Abstract Background Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) maybe at higher risk of HBV infection, especially those on biologic therapies. There is limited data on the effectiveness of HBV vaccination in patients with IBD receiving different types of IBD medications. This study intends to compare the effectiveness of HBV vaccine in patients with ulcerative colitis (UC) on Infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Methods Patients with UC aged between 18-85 years were prospectively enrolled in the study. The patients were divided into two groups: group 1 ( patients with UC on 5-ASA) and group 2 (patients with UC on IFX). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titres were assessed three months after the final dose. The response to HBV vaccines was categorized as 'adequate' immune response (≥10 IU/L) and 'effective' immune response (≥100 IU/L). Results In our final analysis of 118 patients with UC, 54.2% were male, and 52.5% had extensive disease. HBsAb titer levels were significantly higher in the 5ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10-99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L (76.7%) compared to the IFX group (12.1%). Conversely, the IFX group showed a higher percentage of subjects with levels between 10-99 IU/L (87.9%) relative to the 5-ASA group (23.3%). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥100 compared to those on IFX (OR 23.94, 95% CI 8.89-64.49). Conclusion Immune response to hepatitis B vaccination in patient with ulcerative colitis on infliximab is attenuated compared to those on 5-ASA. Therefore emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially infliximab, and advocating for screening is imperative in high risk countries.

Effect of obligatory Hepatitis B vaccination program on the prevalence of occult hepatitis B among pregnant women in Egypt: A cross sectional study

Hepatitis B virus (HBV) infection is a global health problem. HBV is of intermediate endemicity in Egypt. “Occult” HBV (OBI) indicates replication of HBV-DNA in the liver of individuals with negative serum HBsAg. This study aimed to determine the prevalence of OBI among pregnant women in Egypt and to compare this prevalence among HBV vaccinated and unvaccinated women (received obligatory vaccination). This cross-section study included 474 pregnant women in the third trimester divided in two groups. Group I: (n=247) assumed received obligatory hepatitis B vaccination and group II: (n=227), did not receive HBV vaccination. Study participants were screened for HBsAg, anti HBs, anti HBc total, anti HBc IgM, HBeAg, anti HBe, HCV Ab, and HIV Ab by immunoassays and HBV-DNA by Real-Time PCR. Anti HBs was detected in 65 (13.7%) of pregnant women, 36 (14.6%) in the vaccinated group and 29 (12.8%) in the unvaccinated group. The anti HBs levels were significantly higher in the unvaccinated group. HBc Ab showed positive results in 6 cases (2.4%) in the vaccinated group, and 14 cases (6.2%) in unvaccinated group. HBcAb and/or HBsAb were detected in 72 (15.1%) of pregnant women, 39 (15.8%) in the vaccinated group and 33 (14.5%) in the unvaccinated group. HBV-DNA was detected only in one vaccinated pregnant woman. HB vaccination program in Egypt, since 1992 affected the frequency of OBI in pregnant women (p=0.04). In conclusion, HBV infection may persist lifelong in the hepatocytes even when viral functions are suppressed, HBsAb and anti-HBc-positive individuals are present. The levels of HBsAb were higher in unvaccinated pregnant women compared to vaccinated pregnant women. HBV infection in OBI pregnant women may not transmit to the new-born.

Age-related decline in anti-HBV antibodies in vaccinated kidney transplant recipients.

Hepatitis B virus (HBV) vaccination is indicated for all end stage kidney disease patients, including all solid organ transplant candidates. Maintenance of adequate immunity is especially important for immunosuppressed solid organ recipients who are at increased risk for donor or community acquired HBV. The impact of age and immunosuppression on long-term maintenance of HBV immunity postvaccination has not been fully investigated. We performed a single-center retrospective study of 96 kidney transplant recipients, transplanted between July 2012 and December 2020, who had Hepatitis B surface antibody (HBsAb) levels measured pretransplantation and 1-year posttransplantation. We compared the change in HBsAb levels stratified by patient's age (<45, 45-60, and >60) and by whether or not the patient received lymphocyte depleting induction therapy. Our results demonstrate that HBsAb IgG levels vary by age group, decreased significantly at 1-year posttransplant (p < .0001) and were significantly lower in the older cohort (p = .03). Among recipients who received rabbit anti-thymocyte globulin induction (rATG), the log HbsAb levels were significantly lower in the older age group (2.15 in age <45, 1.75 in age 45-60 and 1.47 in age >60, p = .01). Age group (p = .004), recipient HBcAb status (p = .002), and rATG (p = .048) were independently associated with >20% reduction in log HBsAb levels posttransplant. Significant declines in HBsAb levels occur postkidney transplantation, especially in older individuals, thus placing exposed older kidney transplant recipients at greater risk of HBV infection and associated complications.

Effects of hepatitis B virus infection and strategies for preventing mother-to-child transmission on maternal and fetal T-cell immunity.

One of the most common routes of chronic hepatitis B virus (HBV) infection is mother-to-child transmission (MTCT). Approximately 6.4 million children under the age of five have chronic HBV infections worldwide. HBV DNA high level, HBeAg positivity, placental barrier failure, and immaturity of the fetal immune are the possible causes of chronic HBV infection. The passive-active immune program for children, which consists of the hepatitis B vaccine and hepatitis B immunoglobulin, and antiviral therapy for pregnant women who have a high HBV DNA load (greater than 2 × 105 IU/ml), are currently two of the most important ways to prevent the transmission of HBV from mother to child. Unfortunately, some infants still have chronic HBV infections. Some studies have also found that some supplementation during pregnancy can increase cytokine levels and then affect the level of HBsAb in infants. For example, IL-4 can mediate the beneficial effect on infants' HBsAb levels when maternal folic acid supplementation. In addition, new research has indicated that HBV infection in the mother may also be linked to unfavorable outcomes such as gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, and premature rupture of membranes. The changes in the immune environment during pregnancy and the hepatotropic nature of HBV may be the main reasons for the adverse maternal outcomes. It is interesting to note that after delivery, the women who had a chronic HBV infection may spontaneously achieve HBeAg seroconversion and HBsAg seroclearance. The maternal and fetal T-cell immunity in HBV infection is important because adaptive immune responses, especially virus-specific CD8 T-cell responses, are largely responsible for viral clearance and disease pathogenesis during HBV infection. Meanwhile, HBV humoral and T-cell responses are important for the durability of protection after fetal vaccination. This article reviews the literature on immunological characteristics of chronic HBV-infected patients during pregnancy and postpartum, blocking mother-to-child transmissions and related immune mechanisms, hoping to provide new insights for the prevention of HBV MTCT and antiviral intervention during pregnancy and postpartum.

The potential effect of HBV vaccination on off-treatment HBsAg reversion after interferon-induced HBsAg clearance

ABSTRACT Off-treatment HBsAg reversion occurs in a considerable number of chronic hepatitis B(CHB) patients after IFN(interferon)-induced HBsAg clearance. HBV vaccination protects the general population against HBV infection. However, it remains unclear whether HBV vaccination could prevent off-treatment HBsAg reversion in CHB patients with HBsAg clearance. CHB patients (n = 199) with HBsAg clearance were included in the current study, comprising spontaneous HBsAg clearance group (n = 51), NA (nucleoside/nucleotide analogues)-induced group (n = 36) and IFN-induced group (n = 112). Log-rank test was performed to compare the cumulative incidences of HBsAg reversion between groups. Cox regression model was used to identify the factors associated with off-treatment HBsAg reversion. The 5-year cumulative incidence of HBsAg reversion in IFN-induced group was significantly higher than that in NA-induced group or spontaneous group (27.6% vs. 3.3% vs. 8.1%, both p < .05). In IFN-induced group, 66.7% of CHB patients received HBV vaccination. The cumulative incidence of HBsAg reversion in individuals with strong responses to HBV vaccination (HBsAb level >100mIU/ml) was significantly lower than that in those with weak responses to HBV vaccination (HBsAb level ≤100mIU/ml) or without HBV vaccination in IFN-induced group (7.7% vs. 58.5% vs. 31.9%, both p < .05). Multivariate Cox regression analysis confirmed strong responses to HBV vaccination were independently associated with a lower cumulative incidence of HBsAg reversion after IFN-induced HBsAg clearance (HR = 0.246, 95%CI: 0.066–0.907, p = .035). HBV vaccination has potential to prevent off-treatment HBsAg reversion in CHB patients after IFN-induced HBsAg clearance via a sufficiently high level of HBsAb, helping clinicians optimize the clinical management of such patients.

Hepatitis B Virus (HBV) Infection in Patients at Pasteur Institute of Dakar in Senegal from 2016 to 2020: Prevalence and Seroprotection Level

Hepatitis B virus (HBV) infection is highly endemic in Senegal. Vaccination of all children against HBV was introduced in 1999 and included in Expanded Programme on Immunisation in 2005. The aim of this study was to assess the prevalence and immune status against HBV in patients received at Pasteur Institut in Dakar, Senegal. Methods: Between January 2016 and December 2020, patients aged between 1 and 96 years received laboratory were included in the study. Serum samples were analysed for HBV serology (HBs antigen: HBsAg, HBs antibody: HBsAb and HBc antibody: HBcAb) using ARCHITECT? analyser. Patients with anti-HBs antibody levels (HBsAb ≥ 10 IU/l) were considered seroprotected against HBV. Results: A total of 5629 patients were analysed with a mean age of 39 years and extremes from 1 to 96 years. The most represented age group was 31 - 45 years with 38.4%. HBsAg was present in 520 patients (9.2%) and was signed by sex and age group. Anti-HBc antibodies were found in 52.7% of patients and 1603 (28.48%) had isolated anti-HBs antibodies reflecting proportion of people vaccinated at the time of the study. However, 2143 patients (41.9%) had no seroprotection (HBsAb 10 IU/L) and 640 (12.6%) had strong seroprotection defined as HBsAb > 1000 IU/L. Conclusion: Our results show a significant presence of virus in Senegalese population and low vaccination coverage, especially in adults. Evaluation of HBsAb levels and provision of HBV booster shots should be considered for children in Senegal.

Efficacy of a two-dose hepatitis B vaccination with a novel immunostimulatory sequence adjuvant (Heplisav-B) on patients with chronic liver disease: a retrospective study.

Patients with chronic liver disease (CLD) are more likely to have severe morbidity and mortality due to superimposed acute or chronic hepatitis B virus (HBV) infection and should receive routine vaccination against the virus. Heplisav-B is a two-dose, inactivated, yeast-derived vaccine that uses a novel immunostimulatory adjuvant. Our primary objective was to determine the efficacy of hepatitis B vaccination with Heplisav-B in patients with CLD. This retrospective cohort analysis included patients ≥18 years old with CLD who received Heplisav-B from January 2018 to January 2021. All patients had anti-HBs <10 IU/L prior to vaccination and received two doses of Heplisav-B. Post-vaccination anti-HBs of ≥10 IU/L was considered successful vaccination. Basic demographic information, laboratory markers, and medical history were collected from the electronic health record. A total of 120 patients were included in analysis. The average age of patients was 59 years, 37% were female, and the most common etiology of liver disease was nonalcoholic fatty liver disease. Median days from 2nd vaccination to post-vaccination HBsAb levels was 121 days. 81/120 (67.5%) of patients had evidence of active immunity after receipt of Heplisav-B. On multivariable analysis, age >50 was associated with reduced odds of successful vaccination (OR =0.19, 95% CI: 0.03-0.76). In patients with CLD, Heplisav-B's overall efficacy (67.5%) is greater than reports of Engerix-B (33-45%), and thus is an effective hepatitis B vaccine in this patient population, particularly in cirrhotic patients. Further studies regarding this vaccine are needed in patients with CLD and after liver transplantation.

Measuring quality of hepatitis B care in a remote Australian Aboriginal community: opportunities for improvement.

Chronic hepatitis B (CHB) infection remains a significant public health issue for Indigenous Australians, in particular for remote communities. To evaluate the spectrum of hepatitis B virus (HBV) care provided to a remote Aboriginal community. Measures studied included screening, seroprevalence, vaccination rates and efficacy, and HCC risk and surveillance adherence. A retrospective audit of HBV care received by all permanent residents currently attending a remote Aboriginal Health service. This study was endorsed by both the local Aboriginal Health service and the Aboriginal Health Council of South Australia. A total of 208 patients attended the clinic, of whom 52% (109) were screened for HBV. Of these, 12% (13) had CHB and 20% (22) had evidence of past infection. Similarly, of the 208 attending patients, complete vaccination was documented in 48% (99). Of the 33 patients with post-vaccination serology, 24% (8) had subtherapeutic (<10 IU/mL) levels of HBsAb. Subtherapeutic HBsAb was independently associated with higher Charlson Comorbidity scores (odds ratio=17.1; 95% confidence interval 1.2-243.3; P=0.036). Definitive breakthrough infection was identified in 6% (2) patients. One HBsAg positive patient was identified as needing HCC surveillance, but had not undertaken HCC surveillance. Opportunities to improve the quality of CHB care through increased HBV vaccination, screening and adherence to HCC surveillance were identified. High rates of subtherapeutic vaccine responses and documented breakthrough infection raises concerns about the effectiveness of current CHB vaccines in this population.

Hepatitis B Virus Vaccination after Allogeneic Hematopoietic Cell Transplantation Prevents Post-Transplantation Hepatitis B Virus Reactivation

Hepatitis B virus (HBV) reactivation in allogeneic hematopoietic cell transplantation (HCT) recipients with evidence of pretransplantation resolved HBV infection is an important cause of morbidity, usually occurring 1 year or later after HCT. We retrospectively studied a cohort of allogeneic HCT recipients with resolved HBV infection, some of whom were vaccinated for HBV following transplantation, to understand whether post-HCT HBV vaccination influenced the risk of HBV reactivation. The study included all patients with resolved HBV who underwent allogeneic HCT at our institution between January 1, 2000, and December 31, 2015, where HBV vaccination starting at 1 year after HCT became standard in 2012 and antiviral prophylaxis is not used. Resolved HBV infection was defined as positive HBV-core IgG (HBcAb), negative HBV-surface antigen (HBsAg), and undetectable HBV DNA before HCT. HBV reactivation was defined as the development of detectable HBsAg and HBV DNA after HCT. Follow-up for outcomes concluded on January 1, 2018. Among 136 patients with resolved HBV infection before HCT, 19 developed reactivation during follow-up (cumulative incidence, 14%). The median time to HBV reactivation was 21 months (range, 2 to 47 months). When accounting for competing risks, the cumulative incidence of HBV reactivation among HCT recipients who survived for 1 year or longer after transplantation without early HBV reactivation and were HBV vaccinated versus those who were unvaccinated was 2.9% versus 10.0% at 2 years post-HCT and 6.6% versus 26.5% at 4 years post-HCT (P=0.03, Gray's test). In a time-dependent Cox model, the adjusted hazard ratio (aHR) of HBV reactivation in patients with a pretransplantation HBsAb level >10 IU/L was 0.34 (95% confidence interval [CI], 0.13 -0.90). The aHR of HBV reactivation in patients who were vaccinated with 2 or more doses of recombinant HBV vaccine after HCT was 0.18 (95% CI, 0.04-0.80) compared with those who received 1 or no post-HCT vaccine doses. HBV reactivation is a late complication of allogeneic HCT in at-risk recipients, particularly in those with low pre-HCT HBsAb. HBV vaccination starting at 1 year after HCT may be protective.

Protective Role of Rheumatic Diseases Against Hepatitis B Virus Infection and Human Leukocyte Antigen B27 Highlighted.

BackgroundBy determining the hepatitis B virus (HBV) surface antigen (HBsAg) positive rate postexposure and HBV-specific antigen/antibody (Ag/Ab) level in patients with rheumatic diseases, we aimed at exploring the rheumatic link to HBV control.MethodsPatients who underwent HBV screening in the Ruijin Hospital from 2020 to 2021 were enrolled for the exposure rate estimation. Among antibody to HBV core antigen (HBcAb)-positive patients, we adopted propensity score matching (PSM) to study the impact of rheumatism on HBsAg seroprevalence after exposure. A second PSM evaluated the Ag/Ab differences. We also had HBsAg prevalence in human leukocyte antigen B2 (HLA-B27) tested patients studied.ResultsWith 33,989 screened patients, exposure rates remained comparable between rheumatic and non-rheumatic patients: 48.94 vs. 49.86%. PSM first yielded 2,618 balanced pairs. We observed significantly fewer patients with rheumatic diseases in HBsAg positive cases than negative ones (p < 0.001). In the second round, PSM matched 279 pairs, HBsAg (p < 0.001) and HBeAg (p < 0.05) positivity rates were significantly lower in the rheumatic patients, whereas HBsAb positivity rate (p < 0.001) and level (p < 0.01) were significantly higher. Though the value of HBcAb was overall significantly lower (p < 0.001) within the realm of rheumatic diseases, patients with ankylosing spondylitis (AS) demonstrated a significantly higher value than other rheumatic diseases. We saw significantly fewer HBV infections in HLA-B27 positive subjects than in the negative ones (p < 0.001).ConclusionIn this propensity score-matched study, rheumatic patients had an advantage in HBV control. In rheumatic patients, HBcAb levels, together with the beneficial role of HLA-B27, were highlighted.

Hepatitis B Virus Infection in Vaccinated Children and Adolescents with HBsAg-positive Parents: Is Routine Vaccination Sufficient?

Background: Hepatitis B virus (HBV) is a severe public health problem in Iran. This study was conducted to investigate the intrafamilial transmission of HBV in vaccinated children whose one or both parents were positive for hepatitis B surface antigen (HBsAg). Methods: In a study with retrospective cohort design, 110 exposed cases with HBsAg-positive parent(s) were compared with 110 unexposed controls of the same sex and age groups. The participants were directly asked about demographic characteristics, medical history, and vaccinations. Blood samples were collected and analyzed for HBV infection markers using the ELIZA method. Results: Overall, 1.8% HBsAg (P = 0.15) and 13.6% hepatitis B core antibody (HBcAb) (P &lt; 0.0001) positivity rates were detected in the exposed group. The hepatitis B surface antibody titer (HBsAb) showed that 34.5% of cases and 56.3% of controls had HBsAb levels &gt; 10 IU/L. There was a significant difference in the protective HBsAb level between the two groups (P &lt; 0.0001). There were significant associations between HBsAb level and gender in the exposed group and decreased HBsAb levels and age. Conclusions: The high rate of positive HBcAb and HBsAg and decreasing HBsAb levels with age in this study indicate that routine childhood vaccination programs are inadequate in preventing HBV transmission and vaccine routes changing or further booster vaccination is essential. Effective case finding in vaccinated children with HBsAg-positive parents, intradermal vaccination, and hepatitis B immunoglobulin in newborns with HBsAg-positive fathers are suggested.

Prevalence of hepatitis B and C virus infections and immunity among hemodialysis patients in the Mazandaran province, Northern Iran.

ABSTRACTBackground:Hemodialysis (HD) is one of the most common causes of blood-borne infections. In order to prevent viral hepatitis and confront with the virus on the next step, health providers specify infected patients by screening and vaccination. This study is designed to investigate the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in HD patients in Mazandaran, Iran.Methods:The medical records of 216 patients referred to the hemodialysis centers were evaluated in this cross-sectional study between 2019 and 2020. The collected data was analyzed using t-test and Chi-square.Results:Among 216 patients, 106 cases were female (49.07%) and 110 subjects were male (50.9%). The mean age was 40.1 y/o in females and 50.9 y/o in the male patients. The study recorded nine HBs-Ag positive (prevalence: 0.06%) and 15 HCV-Ab positive (prevalence: 6.94%) patients. Also, the most common co-morbidities were diabetes and hypertension. It was observed that 13 patients from 34 patients with negative HBs-Ag (who had 10–100 U HBs-Ab in the first stage) experienced sudden drop in the antibody titration to less than 10 U (P < 0.05). From 50 HBs-Ag negative patients with HBs-Ab more than 100 U in the first stage, antibody titration of five patients was decreased to less than 10 U in the second stage (P < 0.05).Conclusions:The prevalence of HCV and HBV was low in HD patients in Mazandaran province. However, due to the large number of patients with non-protective HBs-Ab levels, there is a risk of an increased prevalence of the disease.

Evaluation of Protective Antibody Titer Against HBs Antigen in Students of Gonabad University of Medical Sciences in 2018

Aims: Hepatitis B infection is one of the common diseases and the most prevalent communicable virus transferred by blood to the healthcare personnel. Active immunity, through vaccination, is the most effective way to prevent hepatitis B infection. The current study aimed to determine the protective antibody titer against HBs antigen in Gonabad University of Medical Sciences students, Gonabad City, Iran, 2018. Methods &amp; Materials: The present cross-sectional study was conducted on 416 students of Gonabad University of Medical Sciences. The HBsAb level was determined in blood samples by an Enzyme-Linked Immunosorbent Assay (ELISA) kit made in Iran. Data were analyzed using descriptive statistics like frequency distribution tables and inferential statistics as independent 2-sample t-test and Chi-square test to determine the relationship between variables. The significance level was considered P&lt;0.05. Findings: HBsAb level of 217 cases (51.8%) was below 10 IU/mL, 96 (61.3%) had an HBsAb level between 10 and 100 IU/mL, and in 106 (36.5%) cases, HBsAb level was above 100 IU/mL. There was no statistically significant difference between the means of HBsAb in terms of gender, age, and body mass index (P&lt;0.05). Conclusion: In general, more than 50% of the study participants had mild immunity against hepatitis B viruses. Therefore, in these people, it is recommended to check the antibody titer periodically to ensure immunity against hepatitis B.

HIV-exposed infants with EBV infection have a reduced persistence of the immune response to the HBV vaccine

BackgroundIn sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi.MethodsA total of 149 HIV-exposed infants were included in this longitudinal study. EBV anti-VCA IgG were measured using an ELISA assay. The EBV seroconversion was correlated with the maternal viro-immunological conditions, with infant growth and immunological vulnerability, and with the humoral response to the HBV vaccine.ResultsNo infant was EBV-positive at 6 months (n. 52 tested). More than a third of infants (49/115 or 42.6 %) on study beyond 6 months seroconverted at 12 months. At 24 months, out of 66 tested infants, only 13 remained EBV-uninfected, while 53 (80.3 %) acquired EBV infection, rising the total proportion of EBV seroconversion to 88.7 % (102/115 infants). EBV seroconversion was significantly associated with a low maternal educational status but had no impact on infant growth or vulnerability to infections. Reduced HBsAb levels and accelerated waning of antibodies were associated with early EBV seroconversion.ConclusionsWe found a heterogeneous timing of acquisition of EBV with the majority of infants born from HIV + mothers acquiring infection after 6 months. Anti-HBs levels were lower and appeared to wane faster in infants acquiring EBV infection.

Hepatitis B Vaccination Coverage, HBS-Ab Level and its Related Factors among Dentistry and Medical Students

Background: In Iran, hepatitis B vaccination has been routinely performed for infants since 1993. This vaccination has also been suggested for individuals at risk. Recently, with the birth of children in 1993 and later to the age of entry to the university, assuming they were vaccinated against hepatitis B at birth, the issue of tracking the immunity of these students has been obscured or neglected. Moreover, the entry of some individuals born before 1993 to the university who have not been immunized against this disease in childhood, has made this issue more complicated. Objectives: The aim of this study was to investigate Hepatitis B Vaccination Coverage, HBS-Ab level and its related factors among dentistry and medical students. Methods: This study was a cross-sectional study performed through providing a checklist and serological tests. After obtaining written consent from the students, the information of 300 students were entered into SPSS software, version 16.0, and analyzed using descriptive statistics. Kruskal-Wallis and Mann-Whitney U tests were used and P&lt;0.05 was considered as statistically significant. Results: Of the 300 students, 55%, 28.7%, and 16.3% had weak, medium, and good HBS-Ab titer with rates of less than 10, 10 to 100, and more than 100, respectively, moreover, the mean HBS-Ab titer was significantly different between different immune groups (Weak, Medium, and Good) (P = 0.000) (Write P&lt;0.001 instead of P = 0.000). Vaccination coverage was at a very low level so that only 6.3% of the subjects completed the hepatitis B vaccination in the past 1 to 5 years (when entering university). the mean HBS-Ab titer was significantly correlated with the time elapsed since the last vaccination (P&lt;0.05) (It was better to write the exact P values). The immunity level among the married individuals and clinical students was significantly higher compared to the single individuals and preclinical students, respectively (P&lt;0.05). Conclusions: Considering the low level of vaccination coverage among the students of Hormozgan University of Medical Sciences (6.3%) compared with other universities, it is better to design a program that will allow all students enrolled in such fields to receive hepatitis B vaccination when entering the university.

Response of Hepatitis B Vaccine in Children with Celiac Disease – An Experience at Ayub Teaching Hospital, Abbottabad Pakistan

Background: Celiac Disease (CD), characterized by chronic small intestinal inflammation, is an immune-mediated disorder, with a strong family history and association with DQ2 HLA haplotype. It has been postulated that children with CD show less response to hepatitis B vaccine due to overexpression of HLA-DQ2 haplotype. This study was done to determine the response of hepatitis B vaccine in children with CD in our tertiary care setting in the Hazara region of eastern Khyber Pakhtunkhwa, Pakistan.Material and Methods: This cross-sectional study was conducted in the Pediatrics outpatient department (OPD) of Ayub Teaching Hospital, Abbottabad Pakistan from April 2018 till March 2020. Children with CD (n=38) aged 1-14 years with completed HBV vaccination, anti-tissue transglutaminase IgA antibody (tTG-IgA) &gt;150 IU/ml and/or typical histological findings of CD on small-bowel biopsy, were included in the study. Hepatitis B surface antibody (HbsAb) titer of ≥10 mIU/ml was taken as antibody positive, while HbsAb levels &lt; 10 mIU/ml were considered as vaccine non-responsive. Data was analyzed using SPSS version 20.0. Chi square test was applied for comparison with P-value &lt; .05 taken as significant.Results: Out of 38 diagnosed cases of CD, 15 (39.5%) were males and 23 (60.5%) were females. Mean age of children was 8.32±3.26 years with an age range of 3-14 years. HbsAb levels ranged from 0.10 to 62.7 mIU/ml with a mean of 11.2+17.42 mIU/ml. HbsAb levels were less than 10.0 IU/ml in 73.7% of children with CD. Small intestinal biopsy was performed in 11 (28.9%) patients. There was a significant relationship between anti tTG-IgA levels and histopathology findings with P-value of .001.Conclusions: In children having celiac disease, there was low rate of protective antibody response to hepatitis B vaccine.